CMS Issues Guidance On CAH Necessary Provider Status

The Centers for Medicare & Medicaid Services has issued Survey and Certification Memo S&C 16-08-CAH. The memo provides state survey agencies with a checklist and guidance for performing surveys and determining critical access hospital compliance with location and distance requirements. Included in the guidance is a procedure for CAHs lacking documentation of the designation of necessary provider status before Jan. 1, 2006. MHA is working with the Department of Health and Senior Services’ Office of Primary Care and Rural Health to obtain necessary documents to comply with CMS’ requirements to maintain CAH status.

The February issue of HIDI HealthStats highlights the importance of including sociodemographic factors in risk-adjusted readmission measures. Using the hierarchical generalized logistic methods and measures used by the Centers for Medicare & Medicaid Services, MHA and the Hospital Industry Data Institute developed a blended clinical and sociodemographic status-enriched methodology to report 30-day risk-standardized readmission rates and ratios for Missouri hospitals participating in the MHA quality transparency initiative. The measures are designed to account for patient-level risk associated with the clinical comorbidities employed by CMS, as well as the effects of select social determinants indicated by patient Medicaid status and the poverty rate of a patient’s home census tract. The SDS-enriched models additionally control for clustering of patients at the census-tract level to help account for differences in access to post-acute care amenities in the patient’s community, such as transitional care, nutritional food outlets and access to transportation for follow-up care.

Hierarchical logistic regression controls for naturally occurring data clustering — or correlation among records from groups of observations nested together in settings such as hospitals or geographic areas — by simultaneously modeling individual- and group-level effects that contribute to the probability the modeled outcome will occur. The SDS-enriched models employed draw from previous peer-reviewed work. The SDS-enriched risk adjustment is designed to estimate and compare each hospital’s performance while controlling for the predicted risk of its patients using the fixed effects (case mix) and the expected risk for patients from similar census tracts in terms of clinical acuity, Medicaid status and poverty rate using the random effects (community mix).

Consider This ...

This week is Cardiac Rehabilitation Week. Each day the average heart beats 100,000 times and pumps about 2,000 gallons of blood. In a 70-year lifetime, an average heart beats more than 2.5 billion times.